Abstract
Introduction:
Blakemore tubes have traditionally been used for the control of acute gastrointestinal (GI) hemorrhage. However, they have become less commonly used. As a result, Blakemore tubes can be difficult to locate in emergent situations. We will discuss two case presentations of acute esophageal bleeding. Aortic occlusion balloons were used to control hemorrhage via tamponade in both situations.
Materials and Methods:
Patient 1 is a 44-year-old female who presented with hematemesis and hemodynamic instability. She had a previous thoracic aortic aneurysm repair. Vascular surgery took her to the OR for concern of an aorto-esophageal fistula. Vascular surgery placed an aortic stent, but there continued to be high-volume hematemesis in the OR. Minimally invasive surgery was emergently consulted. There were no Blakemore tubes available. An aortic occlusion balloon was placed parallel to the endoscope and inflated to provide tamponade. Hemostasis was achieved, and over-the-scope clips were placed. Patient 2 is a 75-year-old male who previously underwent a total gastrectomy with Roux-en-Y esophagojejunostomy. Postoperatively, he had an anastomotic leak, which was treated with endoluminal vacuum therapy. He presented to the hospital with hematemesis and was found to have a near-complete breakdown of his anastomosis, and another endoluminal vacuum was placed. He was later taken to the OR emergently for hematemesis. Upper endoscopy showed bleeding near his anastomotic breakdown. An aortic occlusion balloon was passed in parallel to the endoscope and inflated to provide tamponade. Hemostasis was achieved, and through the scope clips were applied.
Results:
Aortic occlusion balloons were successfully used to treat acute esophageal hemorrhage in two separate patients.
Conclusion:
Aortic occlusion balloons can be successfully used in conjunction with endoscopy to provide hemostasis in acute GI hemorrhage until more definitive treatments can be employed. These devices are particularly useful in situations where Blakemore tubes are unavailable.
Disclosures:
Eric D. Moyer, McKell Quattrone, and Charles C. Vining have no relevant disclosures. Joshua S. Winder is a consultant for Boston Scientific. Eric M. Pauli is a speaker/teacher for Becton-Dickinson, Boston Scientific, C.R. Bard, Cook Biotech, and Ovesco Endoscopy and is a consultant for Actuated Biomedical, Inc., Allergan, Baxter, Boston Scientific Corp., Cook Biotech, Medtronic, and Mesh Suture, Inc. He receives royalties from UpToDate (Wolters Kluwer), Inc. and Springer and has financial interests in IHC, Inc., Contamination Source Identification, and SIG Biomedical.
Recognition of Patient Consent:
Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
Acknowledgements:
No sources of funding or resources were received to support the production of this video case study.
This video case study was presented at The Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Cleveland, OH, April 17–20, 2024.
Runtime of video:
4 mins 52 secs.
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